Musculoskeletal conditions are the commonest cause of severe long term pain and account for half of all chronic conditions in the over 65s. The BOA published guidelines on the musculoskeletal undergraduate curriculum in 2001. It suggested that a minimum of 8 weeks be allocated for the musculoskeletal course. However, a survey of medical schools showed that only 3 to 5 weeks are allocated. Our results suggest that the musculoskeletal course in Manchester is not long enough to gain sufficient knowledge. Therefore we feel that these deficiencies need addressing with a change in the taught undergraduate curriculum

Patients undergoing total hip replacement (THR) often require further orthopaedic surgery including other primary lower limb joint replacements and revision surgery in their lifetime. We analysed the 10-year data of 552 patients who underwent primary total hip replacement between April 1991 and March 1992 at our institute. Data were available for all patients before the index operation. 77% of patients attended their 5-year review and 67% attended their 10-year review. 233 (42%) had had or subsequently had the opposite hip replaced. 30 patients (5%) had a knee replaced and 19 (3%) had both knees replaced. 4.4% underwent revision surgery.

Conclusion: nearly half the total number of these patients will in due course require the opposite hip replaced. 13% will need another major joint surgery (ie revision or TKR). At £6138 for a primary THR and £8500 for revision THR, and the cost of radiographs (£60) and follow-up appointment (£60), the approximate cost implications on a conservative estimate are £13,000.000. These factors including cost implications and human resource requirements will have significant influence on future planning of health care trusts.

We present the early results of a bone conserving implant, the Thrust Plate Prosthesis (TPP) used for the revision of failed resurfacings of the hip in nine patients.

Four revisions were for fractured neck of femurs. The original implant in this fracture group was a McMinn resurfacing. The original acetabular component was retained. Five revisions were due to aseptic loosening. Four of the original implants in this group were Beuchal Pappas (BP) resurfacings and one was a Cormet2000 resurfacing.

In the fracture group the average age was 46yrs (34–70). The time from primary to revision surgery was 5.8 months (3–11). The Harris hip scores improved in all patients to their pre fracture level of 90 (83–99).

In the aseptic loosening group the average age was 62yrs (53–67). The time from primary to revision surgery was 121 months for the BP resurfacings and 19 months for the Cormet. The Harris hip scores also improved in this group to an average of 73.8 (50–100).

Hip resurfacing presents an attractive option for the younger patient. It is a bone conserving procedure with the added benefit of increased stability by using a large diameter head. Fracture of the femoral neck is a specific early complication. The usual treatment of this complication has been revision to a more traditional design, loosing the benefits of bone conservation.

The TPP is a bone preserving implant that has metaphyseal fixation of the proximal femur. It has satisfactory long term results (Huggler, 1993). The use of the TPP for revision of failed resurfacings has proved to be straight forward. Our early results are promising in the fracture group, but revision for aseptic loosening did not correlate with a high hip score. It remains to be proven that revision of a bone conserving hip replacement will maintain a high quality function. For the younger patient with a failed resurfacing, revision with a TPP can offer continued bone conservation.

Aims: Outside of specialist centres, follow up data on knee arthroplasties beyond 3 years is seldom available. We have devised a simple and cost effective tool to enable the average District general Orthopaedic department to assess their long-term outcomes following knee replacements. Methods: 130 patients underwent a total knee arthroplasty in 1997 at Bolton. A simple questionnaire (which could be completed in person or over the telephone) was dispatched to all of the 115 patients still alive. Questions referred to the patientñs satisfaction with their operation, their mobility, visual analogue score for their pain and any complications that had occurred. Results: Within two weeks there were 95(83%) meaningful returns and a further 8(7%) were completed over the telephone. 12(10%) were lost to follow up. Of the 103 questionnaires completed 80(78%) patients were completely satisþed with their joint. 23(22%) patients experienced problems Ð 13 had signiþcant pain (greater than 50% on VAS), 5 thromboembolisms, 4 infections (2 joint, 2 wound) and 1 complained of a shorter leg. Conclusions: With this questionnaire we have quickly and cheaply identiþed our 5-year status for knee arthroplasty. We thus propose it is a useful audit tool for a department such as ours. In addition it may have the potential to identify those patients who would beneþt from hospital review at þve years and thus could be recalled.

Carpal tunnel syndrome is the commonest nerve entrapment syndrome. There is still controversy over the method of anaesthesia for this procedure. There have been many studies to show the effectiveness of local infiltration anaesthesia. However, patients do not always tolerate it, as one of the disadvantages of local anaesthetic is pain on infiltration. Experimental studies have shown that warming local anaesthetic can reduce the pain of injection in normal subjects. The aim of our study is to assess the effect of warming local anaesthetic for carpal tunnel surgery.

We conducted a prospective randomised controlled trial. Sample size was calculated. The study group consisted of patients undergoing carpal tunnel surgery. The treatment group received local anaesthetic at 37°C, the control group at room temperature. Patients were asked to indicate the degree of discomfort on a visual analogue scale (0 to 100).

There was a significant reduction in pain scores in the treatment group. Warming the local anaesthetic produced a mean visual analogue score of 13.8 versus 43 for the control group. These results were statistically significant (p< 0.05).

Many carpal tunnel releases are performed under General Anaesthetic . One of the main reasons cited was poor patient tolerance to local anaesthetic infiltration due to pain. Our results show a significant reduction in the reported pain by warming the local anaesthetic for carpal tunnel release. We suggest that warming local anaesthetic should be best practice for anaesthesia in carpal tunnel release.